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HomeMy WebLinkAboutPermit Miscellaneous 1994-9-29 / ;...- . . '~-. . - YOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRING FEILD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: INSPECTION LINE: 726-3759 726-3769 ~ Job Location: ~'\{)'\S~b-~\\0 Assessors Map #: \R")~ Tax Lot #: C'roc:::f1 owne~J~\\~~-',~\lJ:s.-\(\ ). . - Address: ~{Suthi.Q..-J Phone: #: /~n :lot1~W City: , StJJ. f--),() Zip Code: Y. ,., T J Value ove/Pellet Stovee \~\{)~ Preliminary Inspection is $15.00 (prior to installation of insert) Yood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative fee + $10,00 issuance = $26.20 total ~ \\ ,,~n~ Type of Inspection Reqllested:ifuy\ 't1\.l\\:\\(\f'\ """,--"11 \'t{Y AJ Contractor: ~ ~ ~D,^: - \) Address: 4;oAfJ?> \fiiDf .. Phone #: ~. \\~ll City: ~ill.9tt\~ \tate: Zip Code: q,~ constrllcti~n Contractors Registration #:!), EXPires:--1[) .~~ ~ By signing this permit/application, I agree to call for inspection(s) as required (726-3769). I state that all the information on this permit/application is correct and that I was provided with the Yood Stove Safety information for wood burning appliances and preliminary inspection standards. I further state that the appliance I am ins.talling meets smoke emission standards as set by the Oregon Department of Environmental Quality or the Federal Environmental Protection Agency and I agree to provide the testing approval nllmber to the inspector at the time of inspection. I also lInderstand that if I am reqllesting a preliminary inspection, the wall covering may be required to be removed. ~ UAd rJ ~ _ ~('P 7:' 4t.'f . ~:~::::o._oo~o.ooo.._oo_.o_oo.____.__;;;.;;;;~.;;;_::::0____..____.:.____..._____.._ REQUIRED INSPECTlON(S): - ELLETS-Y .q'{: Job In.M) Date of Application: PREJ;IrINARY #: Vl4-\~ Issued BY:~ ~ Total Amount Collected: Receipt #:, \AQf)Z< Checked for Deliquencies:. Checked for Historical Status: . . """'" '" 4l\ \~ Address: 5D~ Issued by: ~_l Date: q.tq (1- ...-- Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701.055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued. This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: 1. I own, reside in. or will reside in the completed structure. ~ \. 2. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion. 3A. My general contractor is \J\- ~ ~ lit ^-~ <l ~ a 9.D (Name) Contractor regis. # I will instruct my general contractor that all subcontractors who work on the structure must be registered with the Construction Contractors Board. OR D 3B. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board, If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this Quilding permit of the name of the contractor. I hereby certify that the above ioformatioD is correct aDd that I have read and do understand the Information Notice i ProP~jO~~~onsibilities on the reverse Sid/~:;~ ;~~. ~~ ~ ' (Signature of permit applicant) (Date) , / (White copy to issuing agency permit file, pink copy to applicant) e . . . --. information Noiice'io Property Owners Aboui Construciion Responsibiliiies Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the Construction Cotiiractors Board in accordance with ORS 701.055(5). If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure. you will, in most instances, be ruled to be an employer and the people you hire will be employees. As the employer, you must comply with the following: .' ", . . . Oregon's withholding tax law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more infonnation, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance tax: As an employer, you are reqllired to pay a tax for unemployment insurance purposes on the wages of all employees. For more infonnation, call the Oregon Employment Division at the Department of Human Resources at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If YOll fail to obtain workers' compensation insurance. you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 945-7888. U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages. You will be liable for the tax payment even if you didn't actually withhold the tax. For more infonnation, call the Intemal Revenue Service at 1-800-829-1040. OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the pennit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your attention throllgh inspections. Liability and property damage insurance: Contact you~ insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overs pray , water damage from pipe punctllres, fire. or work that must be re-done. Time to supervise employees: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the expertise to act as your own general contractor, to coordinate the work of rough-in and finish trades. and to notify building officials at the appropriate times so tliey can perfonn the required inspections. \ . . .' ~ J '. If you have. adc!itional questions, write or call the Construction Contiaci~rs' Board (PO Box;'14 1.40, Salem, OR 97309-5052. 503/378-4621). The Board is located at 700 Summer St. NE Suite 300. in Salem. . prop-own.pm4 1/94